The World Bank pioneered global HIV and AIDS financing early in the emergency and remains committed to achieving Millennium Development Goal 6, to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment, and mitigation services for those affected by HIV and AIDS.
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This paper summarizes the key findings
of an 'After Action Review' (AAR) that reflects a
decade of experience in designing and implementing ten
HIV/AIDS projects in... Show More + the Caribbean, financed by the World
Bank. The objective is to identify what worked (and what
didn't) in the project approach, design and
implementation, distilling useful lessons for other projects
in small states. Show Less -

The objective of the Pan-Caribbean
Partnership (CARICOM) Against HIV/AIDS Project is to enhance
the Caribbean regional response to HIV/AIDS by: (a)
supporting improvements... Show More + in the policy and legal environments
for addressing HIV/AIDS; (b) strengthening the knowledge
base on HIVIAIDS in the region; and (c) strengthening the
capacity of selected regional institutions to provide public
goods and model tools to help CARICOM member countries
implement their national HIV/AIDS strategic plans. The
restructuring would: (a) revise the Project Development
Objective (PDO) statement to better reflect the outputs and
outcomes that are achievable and attributable to the
project; (b) revise the results framework to align
indicators with the revised PDO; (c) add a new subcomponent
under part B of the project, 'prevention of the spread
of HIV/AIDS', for the provision of mini-grants to
support the subprojects carried out by youth organizations;
(d) amend part C of schedule two to the grant agreement to
reduce the work program for the Caribbean Epidemiology
Center (CAREC) and add the Pan American Health Organization
(PAHO) as the implementing entity in charge of some of the
activities under this component; (e) allow for the
utilization of the 2006 revision of the procurement and
consultant guidelines; and (f) amend schedule one to the
grant agreement to: (i) include a new category of
expenditures for mini-grants; (ii) reallocate resources
among categories of expenditure to take account of the
actual costs of project activities; (iii) allow the
following expenditures to be financed from the proceeds of
the grant: 'goods' under part B, 'prevention
of the spread of HIV/AIDS' and 'Training'
under part A, 'advocacy and policy development'
and part B of the project 'prevention of the spread of
HIV/AIDS'; and (iv) increase the financing percentage
in category five, 'operating expenses' to 100
percent, retroactive to February 26, 2007; and (g) extend
the grant's closing date to June 30,2010. Show Less -

The guiding principles of this work
program are to: (i) promote sectoral leadership; (ii)
strengthen work at the national level; (iii) further develop
the Caribbean... Show More + community education sector HIV/AIDS
coordinator network; and (iv) ensure that processes are
responsive to Task Team Leaders (TTLs) in the regions. The
work is demand-led, and will focus on dialogue at the
country level with both government and development partners.
All work is conducted within the scope of operational work
plans, supporting the regions through participation in the
joint review of projects and working directly on SWAPs with education. Show Less -

Recent studies point to a number of
current and emerging concerns in the health and nutrition of
school-age children in the Caribbean region. Critical among
them are:... Show More + infectious diseases including HIV and other
sexually transmitted infections (STIs); non-communicable
diseases (NCDs); and violence. Common health conditions
including diabetes, hypertension and heart disease in the
adult population can be positively linked to unhealthy
lifestyles in youth. These health challenges, combined with
a large school-age population, which in some countries may
be a sizable third of the overall population, make a strong
national response to the health and nutritional needs of
school-age children particularly vital. As lifelong patterns
of behavior and thinking are established during youth, it is
critical to ensure early and widespread promotion of healthy
practices related to sexual behavior, nutrition and a
healthy lifestyle in general in the school-age population,
resulting in a healthier adult population in the future. The
rapid survey and this resulting report contribute to the
collection of locally relevant evidence, as well as regional
information relevant to School Health and Nutrition (SHN)
and HIV, to build a sound evidence base at both country and
regional levels to inform policy and strategy. It has
further application as a resource for knowledge sharing as
it provides a comparative perspective on activities and
initiatives thus far implemented throughout the Caribbean
region, and on the allocation and mobilization of resources
used to support these activities and initiatives. Show Less -

This report the findings and outcomes of
the three joint UNESCO/World Bank missions to Guyana,
Jamaica, and St. Lucia, and elaborates on next steps
identified for action... Show More + at both national and regional levels.
The report also sets these findings and next steps within
the broader context of the Caribbean plan for action and
presents in its appendixes sample resources to guide the
development of a comprehensive response to Human
Immunodeficiency Virus and Acquired Immune Deficiency
Syndrome (HIV&AIDS) by the education sector. The
priority placed on the education sector's response is
based on evidence that education contributes towards the
knowledge and personal skills essential for the prevention
of HIV, and protects individuals, families, communities,
institutions, and nations from the impact of AIDS. Education
helps to overcome the conditions that facilitate the spread
of HIV and can create the understanding and tolerance that
contribute to reduced stigma and discrimination against
vulnerable and marginalized communities and people living
with HIV. The CARICOM regional body in the Caribbean, as
well as leadership at the national level, has demonstrated
commitment to accelerating the education sector response to
HIV&AIDS. To fully maximize efforts at the national and
regional levels, including (i) information and research;
(ii) capacity building for planning, decision- making and
coordination; (iii) strengthening teacher education and
learning materials; and (iv) stigma, discrimination and
human rights, including attention to cultural differences,
will be addressed more systematically. Show Less -

This report is the result of a
comprehensive, regional, data-driven review of the HIV
epidemic in the Caribbean. Several reports have been
published about the Caribbean... Show More + but none have specifically
focused on a thorough review of data sources, data
collection strategies and detailed epidemiology of the HIV
epidemic. In the past, the Caribbean epidemic has largely
been characterized as a generalized, heterosexual epidemic
on the verge of explosion. The purpose of an HIV
epidemiological synthesis is to assess and analyze new or
recent data to provide strategic direction for the program
development and implementation. New data sources include any
unpublished, unexplored or unanalyzed data, the latest
surveillance data, as well as, biological and behavioral
surveys, STI data, program monitoring data and quantitative
or qualitative research data. The synthesis also tests and
explores an existing hypothesis about the epidemic and
discusses relevant data-based policy implications. For the
Caribbean synthesis, aimed to: 1) analyze HIV transmission
patterns; 2) determine epidemiological and behavioral
drivers in the Caribbean; and 3) analyze the national and
regional responses relative to findings from the analysis. Show Less -

The HIV/AIDS epidemic is a major health
crisis for the Caribbean. According to the latest
indicators, the Caribbean is the second most affected area
of the world, second... Show More + only to Sub-Saharan Africa. It is clear
that in at least several Caribbean countries, HIV/AIDS has
spread beyond a concentrated epidemic tied to high-risk
groups into a generalized epidemic impacting the greater
population. Approximately 440,000 people are currently
living with HIV in the Caribbean and, of these, 53,000
acquired the virus in 2004. In the Caribbean Community
(CARICOM) countries specifically, 370,000 people are
currently living with HIV, with 48,000 of them having
acquired the virus in 2004. Show Less -

The Caribbean Region has the highest HIV
prevalence in the world outside Africa. An estimated 440,000
individuals are HIV positive or a mean prevalence rate of
2.3 percent... Show More + for adults aged 15 to 49, with a range from 1.5
to 4.1 percent. AIDS is the leading cause of death in that
age group. There is still little hard evidence on the
HIV/AIDS epidemic and considerable uncertainty about its
possible future course. The epidemic remains hidden from
view, due in large part to strong stigma and discrimination
within the Region. In some countries HIV/AIDS is considered
a health threat but not a major development threat despite
its potential impact on their economies. National HIV/AIDS
programs are primarily focused on the health sector
response. Treatment is being scaled up with less attention
being paid to prevention and care, to the multi-sector
response and the meaningful engagement of civil society. For
most countries, national strategies, monitoring and
evaluation systems and organizational and governance
structures are weak. This is not due to a lack of political
will but to weak institutional and human capacity. The
HIV/AIDS review team recommends that priority attention for
the national response should include (1) restoring a
strategic balance in national programs with intensified
focus on prevention, (2) launching a concentrated attack on
stigma and discrimination through better analysis
communication strategies and legal action, (3) adopting
simple, low-tech monitoring and evaluation systems to
support interventions based on evidence, (4) enhancing local
capacity through innovative, collaborative means rather than
increases in numbers of staff, and (5) simplifying
implementation processes, especially for smaller states. The
Regional response should be invigorated by improving the
capacity of the Pan Caribbean Partnership Against HIV/AIDS
(PANCAP) and other regional agencies to coordinate the
regional response and to serve national programs more effectively. Show Less -

The Pan-Caribbean Partnership against
HIV/AIDS (PANCAP) was designated an 'international best
practice' by the Joint United Nations Program on
HIV/AIDS (UNAIDS). A case... Show More + study on the Pan-Caribbean
Partnership against HIV/AIDS (PANCAP) in December, 2004. The
Caribbean region is second only to Sub-Saharan Africa in HIV
prevalence with an estimated adult HIV prevalence rate of
2.3 percent in 2003. Approximately 430,000 adults and 23,000
children are living with HIV in the region. HIV/ AIDS are
the leading cause of death among adults in the age group
15-44 years. The epidemic is not just a health problem, but
a developmental and economic problem as it affects the most
productive human resources and redirects efforts from
productive activities to HIV/AIDS treatment and care. A
number of lessons emerge from PANCAP's experience. The
building of the partnership was regionally led and owned. En
Breve is proud to present the HIV/AIDS series which will run
from January until June of 2005. The series looks to raise
awareness on how HIV/AIDS directly affects the overall
development of the region focusing on the Caribbean. Show Less -

The first case of HIV/AIDS was detected
in Barbados in 1984. At that time, HIV/AIDS was viewed more
as a consequence of risky personal behavior by men who have
sex with... Show More + men than as a public health issue that affects the
general population. Since then the number of reported HIV
cases has risen continuously particularly among 15-49 year
olds and the most economically active group, 25-49 year
olds. Today, prevalence among adults in Barbados is
conservatively estimated at over 3 percent. But people who
test positive are estimated to represent only one-fifth of
the infected population. Show Less -

The development objectives of the
Pan-Caribbean Partnership (CARICOM) Against HIV/AIDS Project
is to contribute to halting the spread of AIDS by pursuing a
three-fold... Show More + regional program that effectively halts and
begins to reverse the spread of the HIV/AIDS epidemic by
2015; efficiently provides the beneficiary countries and
populations with the necessary knowledge and tools; and
equitably spreads program benefits. This project is in
support of the third phase of the Multi-Country HIV/AIDS
Prevention and Control Program for the Caribbean Region.
There are four project components. The first focuses on
advocacy and policy development, incorporating human rights
and non-discriminatory practices for persons living with
AIDS (PLWA) in policy and legislation, mobilizing regional
leaders to champion HIV/human rights issues, ensuring
national level policy decisions reflect international best
practice standards, increasing participation of PLWA in
policy dialogues, and expanding analysis of the impact on
key socioeconomic sectors. The second component finances
HIV/AIDS prevention and control by delivering services such
as voluntary counseling and testing, condom social
marketing, and using targeted information, education, and
communications campaigns by age, language, culture, and
logistics to affect behavioral change. The third component
strengthens regional laboratory services to support the
scale-up of treatment and care of people affected by
HIV/AIDS and opportunistic infections like tuberculosis. The
fourth component strengthens the regional response capacity
of key regional institutions that support country efforts
against HIV/AIDS by financing civil works construction and
rehabilitation, equipment, management information systems,
consultant services, and operating expenditures. This
component also ensures effective and efficient coordination
of the regional response. Show Less -

The Caribbean region currently has the
highest prevalence of HIV of any region of the world other
than AIDS-ravaged sub-Saharan Africa. Official figures show
more than... Show More + 360,000 people living with AIDS, but estimates by
UNAIDS place the actual number at over 500,000, adjusting
for underreporting. In the Caribbean, the HIV/AIDS epidemic
has been moving into younger and younger population groups.
About 83 percent of AIDS cases are diagnosed in people
between the ages of 15 and 54, and almost half of these
cases are diagnosed in people ages 25 to 34. These figures
suggest, given an estimated average incubation period of 8
to 10 years from HIV infection to the development of AIDS,
which about half of new HIV infections are occurring among
young people ages 15 to 24. The affected age groups are the
core of the labor force. Among men, the majority of AIDS
cases are in the 30-34 and 25-29 age groups; among women,
the majority of cases are in the 25-29 year-old age bracket,
followed by the 30-34 age groups. Currently, the Caribbean
region has one of the highest rates of new AIDS cases among
women in the Americas, reflecting the growing
'feminization' of the HIVIAIDS epidemic. Also, the
percentage of AIDS cases who are children infected by
HIV-positive mothers is higher in the Caribbean region than
in any other part of the Americas. More than 80,000 children
have been orphaned by AIDS. Overall the infection rate is
estimated to have reached 12 percent of the population in
some urban areas. Show Less -